NYC 9/11 Public Portal Document
jy109 A'1
NEW YORK CITY HOUSING AUTHORITY
LEAD DETECTION AND ABATEMENT UNIT
DUST WIPE SAMPLE CHAIN OF CUSTODY
Contract #
Date .. - l l/l 0./.. Inspector's Name ,.-~7.•#- , , -- .......
Development Release #.. .........................
St el4ni .....O/ ......................................••
Address S'r
Z .. ,-.., qtr d
'i L ,.~
Fax to (718) 707-5255; Attn: Raphael Flc
A artment/Fac' i T e /~i G vP 1ai
4$ ReportBills must be submitted to:
NYCHA—Technical Services-LDAU
EDP # .. 5 .... SH # 1 Vleairance Category: -•...I...--...._. th
23-02 49thAvenue, 5 floor
LDAU Ticket #/Note:....•..................•---------.............................................. Long Island City, NY 11101
Clearance Cate ories:
1. Interior Treatment without Containment 3. Exterior Work On Painted Surfaces 5. Soil Work
2. Interior Treatment with Containment 4. Routine Maintenance 6. 504 Apartment
SAMPLE AREA LAB
SAMPLE ID ROOM EQUIVALENT SURFACE TYPE DIMENSIONS f: RESULT
(Month-Date-Initials-No.) (in inches) ( ) (µg/f2)
WS WW ST SL
-/9 __1* -3/ / 9N- Pr e eo • d~
/Z X/7i
r1/1 BLANK Other.
Wa WW ai AL L x/
other ?j
WS WW ST SL
--/ -J - - 3 3 /9 s ' /si' ; Cbr~,bPi l e Other: /ax `Z
-- 3 S' F, !
WS WW ST SL X
Z /
k I -- \
-- -- d Other l / --
I,ii,WS WW ST SL
-- -- -- 3 pos 1/ pm er
hi!
I -
- t!./ -- -- --
--3Gi gS - ed •/ ,moo
.I r C L,_ ~, r 1n y1,
WS WW
Other:
ST SL I/ Z X
Iiu WS WW ST SL
2/ / r —
, /
/ -.7 w Wei l I vv -
FL WS WW ST SL X
-- -- Other.
FL WS WW ST SL X
-- -- I lOther:
FL WS WW ST SL X
-- -- -- Th lOther:
FL WSWWS X
-- -- -- Other.
FL WW ST SL X
FL WS W* ST SL X
-- — -- Other.
FL WS WW ST SL X
FLWS W STSL X
-- -- -- Other.
FL WS WW ST NS X
-- -- -- Other
FL WS WW ST SL X
-- Other . ._ _..
FLWSWWSTSL
-- -- Other.
TREAD: SL = STAIR LANDI
ABBREVIATIONS: FL= FLOOR; R'S = W NDOW SILL; WINV =WIDOW WELL; ST = STAIR
Sampled By: ...... `T l tl .1. ............... Date: ...............
... <...... Time: ~/GI%OAS
l?~
Relinquished By:.. J.;G (~....
tr. .J ................... Date: . ...~1 ..~.~1... Time:
......................................... Date: ~~..........1 t 9..I.. .... Time: •
Received By: .........Q.
...............Cede.k
.............
Analyzed By: ................................................................................. Date: ...................................Time:
Total number of samples on this page
Required Turnaround Time (TAT) is _. _... hrs
NYC-WTC 000106072
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